Provider Demographics
NPI:1104467315
Name:GARZON-KASHANI, VERONICA D (PA-C)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:D
Last Name:GARZON-KASHANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NEWMAN SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1530
Mailing Address - Country:US
Mailing Address - Phone:609-426-4300
Mailing Address - Fax:
Practice Address - Street 1:46 NEWMAN SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1530
Practice Address - Country:US
Practice Address - Phone:609-426-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00543300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant